Thursday, July 29, 2010

Delaware Media Group: Sleazy MECC of the Month

As pressure continues to build on various medical organizations to curb industry funding of CME, the companies and their MECC minions (MECC = Medical Education Communication Company) continue to churn out infomercials with the ACCME stamp of approval.

The sleazy "MECC of the Month" is theDelaware Media Group. Here is how they describe themselves on their home page:

“Delaware Media Group
Custom Health Care Communications

Delaware Media Group (DMG) is a fast-growing health care communications/education company that specializes in providing customized communications vehicles to suit your marketing and continuing education needs and goals and enhance your relationships with key customers in the health care community.”

The fact that DMG pairs “marketing” with “continuing education needs” in their promotional material pretty much says it all. This is an outfit whose raison d’etre is to help drug companies sell their products.

Their major marketing vehicle is a pseudo-journal called “Counseling Points” .Each issue focuses on a different topic of interest to the supporting drug company. Who actually creates the content is always confusing, however. For example, I was just sent the June 2010 issue of Counseling Points, entitled "Challenges in Schizophrenia: Overcoming Nonadherence and Preventing Relapse in Schizophrenia."

In the increasingly rare real world of medical education (doctors honestly imparting their clinical wisdom to other doctors), there is an “article” and there is an “author.” The author is an academic doctor who came up with the idea for the article, wrote it, and sent it somewhere for publication. You can trust the content because you know who wrote it and why.

But in the world of industry-funded CME, articles become “activities,” and a basic 9 page piece on the treatment of schizophrenia suddenly requires a whole army of staff: three “faculty” (in this case, three psychiatrists--Christoph Correll, John Kane, and John Lauriello), nine “planners” and “managers”(a smattering of nurses, pharmacists, medical writers, and logistics coordinators), two “co-sponsors” (the “Annenberg Center for Health Sciences” and Delaware Media Group), one collaborator (“Postgraduate Institute for Medicine”), and of course, propping up the entire charade, the commercial supporter, in this case Janssen.

So who actually wrote the darn thing, you might ask? It’s impossible to say in this musical chairs game of “content creation.”

Speaking of content, what does this article have to say? Very little that is surprising. The main points are the following:

1. Schizophrenic patients often don’t take their medications, and there are a bunch of reasons why.

2. When schizophrenic patients stop taking their medications, they get worse.

3. Here are some helpful tips on how to keep your schizophrenic patients on their medications. This section begins with a half page on psychoeducation and cognitive behavioral therapy, followed by two beefy pages on long-acting injectable antipsychotics. And guess what? The major manufacturer of these drugs happens to be Janssen, which funded this article. Janssen markets both Risperdal Consta and Invega Sustenna.

I know this topic well. I read the entire article, and I found nothing in it that was inaccurate. Nor did I find any blatantly biased statements about Risperdal Consta or Invega Sustenna being better than its competitors. The bias is much more subtle. For example, they discuss their arch-rival Zyprexa Relprevv only once, and here’s what they have to say: “As in the presumed cause of olanzapine palmoate postinjection delirium and sedation, there is always a chance that an injected drug can reach the venous space instead of the muscle.”

Wow—there's a portrait of olanzapine that doesn’t exactly make me want to rush out and start prescribing it. But here's what they left unmentioned: This side effect occurs in only 0.07% of injections (see the reference here). That means only 7 out of 10,000 injections, making it a very rare side effect. This additional information would have been a helpful clarification. But it wouldn't have made its competitor look quite as lame--which is why they left it out.

No, there is nothing inaccurate in the article. Just like drug company ads in journals, everything is carefully vetted to be completely accurate, but, just like advertisements, it is just as carefully crafted to increase prescriptions of the company’s products.

And this is why relying on pharmaceutical companies to pay for our CME is such a dangerous game--there is no longer any difference between advertisement and education.

11 comments:

Anonymous
said...

Danny,

This is branded education otherwise known as promotional education not certified CME. This is customer education about a specific product, as mandated and approved by the US Food and Drug administration

Undoubtedly, a medical writer wrote that article, and even in the absence of guidance or contact with the sponsor, that writer knew how to craft the piece so the sponsor would be pleased, while meeting the requirements of ACCME.

The most valued writers are skilled at hiding bias so the article looks like "objective, fair and balanced" CME. When you know who's buttering your bread, you get so good at planting bias by stealth, you can even fool yourself. After awhile, it becomes automatic.

With all due respect to the author of this blog, I still think he's missing the biggest issue about what's wrong with these "educational" pieces. It's not just about a conflict of interest and a bias towards marketing of one drug over another. Rather they are a fount of misinformation and distortion of the "disease" process. They are based on false assumptions about what's really making the patient "worse" and blaming the patient for "non-adherence." Sure stopping meds makes the patient worse but the implicit assumption is that's because the schizophrenia is roaring back. There is not even the slightest nod to the fact that the drugs may be sensitizing the brain to psychosis, lowering the threshold when the drug is removed, and that this whole process may have nothing to do with the "disease" itself and everything to do with how the drugs affect the chemistry of the brain. This doesn't even seem to be on the radar screen of the writers or the medical profession as a whole. If it really is the drugs that are making these victims worse, then somebody should be stepping up to the plate and challenging the drug manufacturers to investigate this and then we need to come up with some new paradigms that might actually help people control their disorder with some real healing mechanisms. What a concept!

These CME programs need to be challenged on a fundamental basis that extends far beyond whether they are marketing/advertising vehicles. To me that is a minor issue in the whole problem of what's wrong with these self-serving educational programs that miss the whole point of what's going on in mental health treatment today. Let's start looking at things a bit more from the patient's perspective and not assume that he/she isn't making some sense when they choose to stop meds. Let's really understand the reasons behind non-compliance and whether there isn't a reason, however subconscious, as to why someone wants to stop treatment. Let's listen to what a patient is telling us about how the meds are affecting him/her.

These have been my observations for years but recently Robert Whitaker has articulated the case very well in his book Anatomy of an Epidemic.

@ Sara thanks for sharing your perspective, I'm glad that you don't see a patient's decision as a 'symptom'. I recently joined a group on facebook called "The Psychiatry Consultant" and the attitude you talked about was reflected by one of their status messages, "(The Psychiatry Consultant) Would like to point out that there is an obvious logical flaw in the sentence: "I'm better now so I can stop taking the medication." So this is what they learn in their psychiatry residency

Sara is right on. The author of this blog has no clue how to treat schizophrenia, he's to busy seeing private patients and collecting 400/hr for a med check.One key problem in the treatment of serious mental illness is the wrap around services are too often lacking, medications are just a small part of the solution. Let's get psychiatry to focus on it's most needy patients and get the resources that are needed!

"There is not even the slightest nod to the fact that the drugs may be sensitizing the brain to psychosis..."

Sara, i have never heard of such a thing but find the idea fascinating. The only time in my life that i have ever experienced auditory hallucinations was for a short period (4 to 9 days) after i took an overdose of the atypical antipsychotic that i was on (they may have started earlier, but i was intubated initially and lost a couple days of memory). I have always wondered about that.

To be clear, i am not commenting on how or whether schizophrenic patients should be medicated; i don't have the knowledge or experience to speak to that. I am simply curious about this strange effect that i experienced.

Dr CarlatYou have a helpful and powerful perspective. Thank you. What is your opinion regarding a similar situation, as I see it, with regard to broadcast media? It seems to me that the powers-that-be have the same type of influence with the news media as pharm companies have w our profession. One can't tell anymore what is commentary, what is unbiased news and even what is outright propaganda. On Fox it favors the right. On the other outlets including NPR, it leans left. This becomes very important when issues such as the health care debate are before the nation. I would enjoy hearing your take. Thank you.